In the initial months of the COVID-19 pandemic, data from the Centers for Disease Control and Prevention (CDC) showed that childhood immunizations and well-child visits were declining. Nationwide Children’s Hospital, in fact, published a study in the journal Pediatrics in January 2021 showing the hospital’s measles vaccination rate across its primary care network had dropped by more than 10%.
That raised the potential of a “twindemic,” says Sara Bode, MD, medical director of Nationwide Children's Care Connection School-Based Health and Mobile Clinics and the co-director of the hospital’s Pediatric Residency Advocacy Training. That is, along with COVID-19, there was concern that conditions normally controlled with preventive care and/or regular vaccines could re-emerge.
Nationwide Children’s efforts to address this, through first-of-their kind “roving” vaccine clinics and a primary care text reminder system, were among the winners of a national competition developed by the Health Resources and Services Administration (HRSA).
More importantly, the efforts resulted in tens of thousands of vaccinations that may not have happened otherwise.
“Our program won because it was a comprehensive approach that looked at the full population, realizing that different families have different needs and that just one solution wasn’t going to help everyone,” says Dr. Bode.
In December of 2020, HRSA announced the Promoting Pediatric Primary Prevention (P4) Challenge. Pediatric clinics, community organizations, children’s hospitals and other health care organizations were invited to propose and implement innovative approaches that would increase well-child visits and immunizations while reducing disparities within the community.
Nationwide Children's school-based health program, Care Connection, entered the challenge with what it called Team WINS (Well Care and Immunization Novel Solutions) and set out to improve immunizations and well care through a two-pronged approach: roving vaccine clinics and a primary care texting initiative.
The roving vaccine clinics targeted children who were not coming in for services by bringing health care to them in schools, community centers, housing complexes and homeless shelters.
While Nationwide Children’s has offered vaccinations in school-based health clinics for years, roving vaccine clinics are novel for a children’s hospital. Five to seven teams carrying temperature-controlled coolers filled with vaccines were dispatched to as many as five locations a day, setting up the clinics in lobbies and classrooms. To determine the sites for the roving vaccine clinics, the team relied on the hospital’s long-standing partnerships with Columbus Public Health and various community organizations.
In total, the roving clinics administered 52,819 vaccinations to children in Franklin County. After the COVID vaccine was approved for children, the teams administered 2,513 COVID vaccines. However, the initiative was focused on routine immunizations to mitigate the risk of a second outbreak of a highly contagious disease like measles. The team administered 30,306 routine immunizations.
The second part of the program was a texting initiative targeting families who were established with a pediatrician but had fallen behind on their routine immunizations and well care during the pandemic. Those families were sent text messages with a direct link to schedule an appointment with their pediatrician.
By entering and becoming one of the organizations to win the P4 Challenge, Nationwide Children’s was able to publicize their work nationally to be discussed and replicated by other institutions. Team WINS demonstrates that population health initiatives are critical to reaching children and families that aren't served by traditional health care.
The roving vaccine clinics will continue as a new, third arm of the hospital’s school-based health program, which includes 15 fixed-site school-based health centers and two mobile medical units. The $25,000 that was awarded to winners of the P4 Challenge will be used to purchase high-quality, temperature-controlled coolers to expand the capacity of the roving clinics.
“If we are going to be a quality health care provider and care about equity, we have to know that the current system doesn't work for everyone,” says Dr. Bode. “We need new strategies to ensure families can get equal access to our services. That's the whole mission of our work.”